{
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"FirstLineMailingAddress": "3 BROADMOOR AVE",
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"MailingAddressCityName": "COLORADO SPRINGS",
"MailingAddressStateName": "CO",
"MailingAddressPostalCode": "80906-3641",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "908-566-5072",
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"FirstLinePracticeLocationAddress": "525 E FOUNTAIN BLVD STE 150",
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"PracticeLocationAddressCityName": "COLORADO SPRINGS",
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"EnumerationDate": "12/02/2024",
"LastUpdateDate": "12/02/2024",
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"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KELLER",
"AuthorizedOfficialFirstName": "CARYN",
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"AuthorizedOfficialCredential": "PT, DPT, NCS",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Physical Therapist",
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"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}